More than half of the biggest cities in the U.S. don’t have adequate health policy to improve their residents’ health and well-being, according to a recent report by the CityHealth Initiative.
The two-year “gold standard” analysis was commissioned by the de Beaumont Foundation, a private organization devoted to public health. It awarded the nation’s 40 largest cities with gold, silver, bronze or no medals, depending on the strength and number of their policies in nine health-related areas.
Twenty-one of the 40 biggest U.S. cities had so much room for improvement they were awarded no overall medal by CityHealth.
“We really want to see progress and have these cities hit their goals when it comes to improving the health and vitality of people in their communities,” said Ed Hunter, president and chief executive of the de Beaumont Foundation. “We don’t need cities to reinvent the wheel. We just need to make sure they apply the learning of other cities where efforts are already working.”
The CityHealth analysis rated each city in each of these nine policy areas: Clean indoor air; healthy food options; tobacco prevention; alcohol sales control; food safety and restaurant inspections; affordable housing; high-quality pre-kindergarten access; paid sick leave; and “complete streets,” a category for policies that allow people to safely walk, bike, drive and take public transit.
Cities that received three or fewer individual policy medals received an overall zero-medal rating. The 21 “no medal” cities were Albuquerque; Austin, Texas; Columbus, Ohio; Dallas; Detroit; El Paso, Texas; Fort Worth, Texas; Indianapolis; Jacksonville, Mississippi; Las Vegas; Louisville, Kentucky; Memphis, Tennessee; Mesa, Arizona; Milwaukee; Nashville; Oklahoma City; Phoenix; Portland, Oregon; San Antonio; Tucson, Arizona; and Virginia Beach, Virginia.
CityHealth awarded five overall gold medals to cities that had five or more individual gold-rated policy rankings: Boston, Chicago, Los Angeles, New York and Washington, D.C.
The organization gave overall silver medals to Philadelphia, along with California cities: Sacramento, San Diego, San Francisco and San Jose. Cities given overall bronze medals were Atlanta; Baltimore, Maryland; Charlotte, North Carolina; Denver; Fresno, California; Houston; Kansas City, Missouri; Long Beach, California; and Seattle.
The CityHealth analysis showed cities are making great progress towards meeting recommendations from the American Heart Association in the areas of healthy food options, tobacco prevention and the importance of physical activity such as walking and biking.
“Cities across the nation should focus on heart-healthy policy change in all neighborhoods to move their communities forward. Walkable, smoke-free communities with access to healthy foods ensure that families can live healthier lives,” said Eduardo Sanchez, M.D., chief medical officer for prevention and chief of the Center for Health Metrics and Evaluation for the American Heart Association.
Tobacco smoke was an area where U.S. cities scored mixed results. While 36 cities earned individual medals for smoke-free air laws, only 13 cities earned medals for having laws that restrict people under 21 from buying tobacco.
“None of the individual areas is going to solve the overall health picture of a city. These are all connected concepts that work in concert to build a strong, healthy community,” Hunter said. “The ability to eat in a restaurant that doesn’t expose you to second-hand smoke is important, just as it’s important to know the food is safe before you go into that restaurant. Eating healthy food in a city facility is important, but so is your ability to walk to that facility or school.”
CityHealth will monitor each city’s health policy progress over the next three years and update its ratings after that. Until then, the de Beaumont Foundation plans to offer resources and technical assistance to help cities create better policies to improve peoples’ health.
“We want to work with cities and nonprofits and foundations to get every city to gold,” Hunter said.
Previous big city-health studies have tended to compare things like mortality or obesity rates while CityHealth focuses on health policies that “will shape eventual outcomes,” Hunter said. “Policy is such an effective tool, because when you enact policy at a city level, it affects everyone. These are achievable policies with bipartisan support.”
The key, he said, is having city residents make their support for these policies known.
“Action starts locally,” Hunter said. “We hope average citizens read this report and say ‘I’d like to live in a city that looks like that’ and they make sure their voices are heard.”